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At least 19 recordsLinked to original sources
PubMed1982

Extracranial surgical procedures in the management of vertebrobasilar insufficiency.

Vertebrobasilar insufficiency is an important syndrome in the spectrum of cerebrovascular disease. Its clinical importance and the frequency of its clinical manifestations are often underestimated. Our experience with a large population of patients having extensive cerebrovascular disease has led us to recognize two classes of vertebrobasilar insufficiency--simple and complex--and, also, to recognize that vertebrobasilar insufficiency is often associated with disease in multiple extracranial vessels. Until recently, direct approaches to the vertebral artery have been underutilized for these patients. In fact, there has been a tendency either to relegate patients with vertebrobasilar disease to medical follow-up or to surgical procedures upon the carotid system. We believe that the resurgence of neurosurgical interest in the vertebrobasilar system is most appropriate. Furthermore, the active interest that neurosurgeons are now taking in developing procedures for managing extracranial vertebral artery problems is in the best interest of patients with cerebrovascular disease. We believe that careful neurosurgical evaluation of patients with simple and complex vertebrobasilar insufficiency will lead to appropriate selection of candidates for vascular reconstruction of the vertebral system. Finally, we believe that vertebral artery to common carotid artery transposition, and its variations, is a procedure that has an important role in the management of cerebrovascular disease.

Adult↗
PubMed1983

The surgical management of vertebrobasilar insufficiency.

Vertebrobasilar insufficiency may result from structural lesions anywhere along the vertebrobasilar system. Recently developed techniques in angiography and microsurgery have made the vertebrobasilar system more accessible to surgical therapy. The syndrome of vertebrobasilar insufficiency is discussed, and our experience with the surgical treatment of lesions from the vertebral origin to the distal basilar region is reviewed.

Anticoagulants↗
PubMed1983

Vertebrosubclavian angioplasty in the treatment of vertebrobasilar insufficiency.

Vertebrobasilar insufficiency is not an uncommon disorder. Five patients with vertebrobasilar syndrome due to stenosis of the vertebral artery at its origin from the subclavian artery were treated surgically by vertebrosubclavian angioplasty, with good results. When vertebral reconstruction is indicated, the results of operation are satisfactory.

Adult↗
PubMed1997

[Vertebrobasilar insufficiency].

Vertebrobasilar insufficiency is a very imprecise and much too frequently applied diagnostic term, usually used to classify uncharacteristic intermittent symptoms such as dizziness or visual blurring. Detailed history may make it possible to identify more specific details. Diagnostic attempts nowadays should aim at identifying underlying pathophysiologic mechanisms: intrinsic vessel disease (e.g. atherosclerosis), extrinsic vessel compression (e.g. cervical spondylarthrosis), systemic affections (e.g. anemia, hypotension), or combined etiologies. Accordingly, various therapeutic options exist. Ultrasound examination of the vertebrobasilar system is a reliable screening method in skilled hands, though its sensitivity is lower than in carotid artery disease. To identify the site and nature of the underlying pathology, digital angiography and, probably soon, magnetic resonance angiography (MRA) are available.

Diagnosis, Differential↗
PubMed2006

Vertebrobasilar insufficiency.

Vertebrobasilar insufficiency presents with characteristic symptoms and signs due to impaired perfusion of the cerebellum, the brain stem, and the occipital cortex. This may be due to reduced perfusion usually due to atherosclerosis or thromboembolism. Choice of treatment depends on understanding the different underlying pathophysiologic mechanisms. Antiplatelet therapy; reduction of risk factors such as diabetes, hypertension, hypercholesterolemia, and cigarette smoking; and a healthy lifestyle form the first line of management. Systemic anticoagulation in the short term also has a key role in selected cases. In patients with refractory symptoms on maximal medical therapy and underlying focal stenotic lesions, endovascular revascularization using stents and balloon angioplasty may be indicated. Bypass surgery is another option if there are factors that render endovascular therapy unsuitable.

Journal Article↗
PubMed2003

[Radiologic investigation of vertebrobasilar insufficiency and quantification of vertebrobasilar flow with magnetic resonance imaging].

PURPOSE: To evaluate the contribution of cervical spine radiograms, Doppler US, cervical and cranial MRI, MRA and two dimensional quantification flow in the diagnosis of vertebrobasilar insufficiency. MATERIALS AND METHODS: We prospectively examined 25 patients having signs of vertebrobasilar insufficiency (16 females and 9 males, aged 34 to 74 years) and 25 controls of the same age and sex with MRI, MRA, Doppler US and cervical radiograms. Cervical spine radiograms were evaluated for the presence of degenerative changes, osteophytes and loss of height. The flow velocities of the basilar artery and vertebral arteries were measured with two dimensional quantification flow, using time-velocity graphics achieved by means of a region of interest drawn on transverse sections of the vessels. Posterior circulation in farcts and slow flow in vertebrobasilar system arteries were investigated on brain MR images and the presence of cervical osteophytes, spinal cord compression and the effect of the presence of degenerative changes on vertebral arteries were evaluated on cervical MR images. Paired samples T-test, independent samples T-test, Wilcoxon W, Mann-Whitney U and chi-square tests were used for statistical analysis. The significance level was taken at p below 0.05. RESULTS: From the statistical analysis, we found that there were more pathologic findings on MRA within the patient group compared with the controls (p = 0.002). The velocities measured by MRI were significantly affected by the presence of unknown bright objects on brain MR images, osteophytes on cervical MR images, loss of height and the presence of osteophytes on radiograms in patients having VBI signs, when compared to the controls. In both groups, the measurements of flow velocity in vertebral arteries by Doppler US did not correlate with the measurements by two dimensional quantification flow. CONCLUSION: Among the methods we used in our study, MRA was the most specific in the diagnosis of patients with vertebrobasilar insufficiency. However, two dimensional quantification flow can be used as a noninvasive but indirect method to investigate the influence of several factors on the hemodynamics.

Adult↗
PubMedDate not supplied

External carotid-vertebral artery anastomosis for vertebrobasilar insufficiency.

Surgical treatment of vertebrobasilar insufficiency has long lagged behind that of carotid disease. However, as more aggressive microsurgical techniques have been developed, surgical intervention in vertebrobasilar occlusive disease is seen with increasing frequency. The authors describe three cases of external carotid vertebral artery anastomosis, a rarely reported operative procedure, in which blood flow was successfully restored to the diseased vertebral artery. Awareness of this new technique will be useful to the radiologist servicing an active neurosurgery practice. The clinical, radiologic, and pathologic manifestations of vertebrobasilar insufficiency are also briefly reviewed.

Angiography↗
PubMed1991

Noninvasive evaluation of vertebrobasilar insufficiency.

The diagnosis of vertebrobasilar insufficiency (VBI) is a clinical challenge because its manifestations are subjective and difficult to quantify. We evaluate 61 patients with the clinical diagnosis of VBI and 30 control patients with other medical problems. We used duplex scanning to study the extracranial carotid, vertebral, and subclavian arteries, and a 2-MHz transcranial Doppler (TCD) to examine the intracranial vertebral and basilar arteries. Extracranial lesions were more common in VBI patients than among controls, including stenosis of the subclavian artery with and without subclavian-vertebral steal and stenosis of the vertebral artery. Intracranial abnormalities identified in the vertebrobasilar circulation included stenosis and occlusion of the intracranial vertebral artery and basilar artery steal. Overall, significant lesions were detected in 32.8% of VBI patients and 3.0% of controls (P less than 0.05). Systolic artery velocity (cm/sec) in the extracranial vertebral artery was higher in controls (65.9 +/- 23.3) than in VBI patients who had no evidence of vertebrobasilar steal (43.0 +/- 17.4, P less than 0.05). Patients with a steal mechanism had an intracranial vertebral artery systolic velocity of 90.0 +/- 38.9, compared with 53.0 +/- 15.0 in controls (2P less than 0.050). Intracranial vertebral artery systolic velocity was higher among VBI patients with significant carotid artery disease (greater than 50%, 76.7 +/- 28.8) than in those with less severe disease (less than 50%, 47.3 +/- 13.8, P less than 0.05). Evaluation and quantitation of the vertebrobasilar circulation using both intra- and extracranial noninvasive studies may afford further insight as to the pathophysiology of vertebrobasilar insufficiency and provide a readily available, direct, and simple method of initial and serial assessment of VBI patients.

Arterial Occlusive Diseases↗
PubMedDate not supplied

Vestibular and oculomotor abnormalities in vertebrobasilar insufficiency.

The early diagnosis of vertebrobasilar insufficiency in patients with vertigo as their only symptom was attempted using a battery of vestibulo-oculomotor tests. With this testing procedure, we were able to find abnormal vestibulo-oculomotor mechanisms that could account for the vertigo in 41 of 42 patients. These abnormalities, however, did not fall into an easily recognizable pattern that could be considered characteristic of vertebrobasilar insufficiency. The large intersubject variability probably arises from the very different and widespread lesions that occur at the vestibular and neurological levels as a consequence of vertebrobasilar insufficiency.

Acoustic Stimulation↗
PubMed1998

Four cases of vertebrobasilar insufficiency.

Four cases of vertebrobasilar insufficiency are reported. Case 1 was a 38-year-old man who felt a sudden onset of dizziness when he turned his head to the back. An abnormal positional nystagmus was observed when he rotated his head to the left. A magnetic resonance angiogram (MRA) demonstrated total occlusion of the left vertebral artery (VA). Case 2 was a 31-year-old woman who had a total occlusion of her left VA as observed in the MRA. Case 3 was a 68-year-old man who noted dizziness. The systolic blood pressure change on his Schellong test was 28 mmHg. On his MRA, severe displacement of the basilar and the vertebral arteries was visible. Case 4 was a 76-year-old woman who noted a blackout-like sensation. Optokinetic nystagmus was noted with a hyponystagmus pattern, and an eye tracking test showed a saccadic pattern. On her MRA, the vertebrobasilar system was narrowed. The arterial architecture and any stenosis of the blood vessels could be detected non-invasively by MRA.

Adult↗
PubMed1992

Surgical correction and SPECT imaging of vertebrobasilar insufficiency due to unilateral vertebral artery stenosis.

BACKGROUND AND PURPOSE: Incapacitating vertebrobasilar insufficiency is generally associated with bilateral vertebral artery disease, whereas unilateral vertebral artery stenosis usually is clinically silent. Regional brain perfusion has not been part of the routine evaluation of patients with vertebrobasilar insufficiency. This report describes two patients who had isolated unilateral vertebral artery stenosis operatively corrected to eliminate their incapacitating vertebrobasilar insufficiency. Hindbrain hypoperfusion was identified preoperatively and evaluated postoperatively, then correlated with patient presentation and response to revascularization. CASE DESCRIPTION: Two patients with incapacitating vertebrobasilar insufficiency presented with isolated unilateral vertebral artery stenosis with patent, nonstenotic internal carotid arteries. Hindbrain hypoperfusion was demonstrated by iodine-123-iodoamphetamine single-photon emission computed tomography preoperatively and demonstrated significant improvement following vertebral-carotid reimplantation. The patients' symptoms resolved following revascularization. CONCLUSIONS: Although unusual, unilateral vertebral artery stenosis can cause incapacitating vertebrobasilar insufficiency. These cases demonstrate the value of imaging with single-photon emission computed tomography to evaluate regional brain hypoperfusion and to evaluate objectively the results of therapy.

Aged↗
PubMed2005

[Effects of acupuncture on TCD and BAEP in the patient of vertebrobasilar insufficiency].

OBJECTIVE: To explore mechanisms of acupuncture in treatment of vertebrobasilar insufficiency. METHODS: Forty cases of vertebrobasilar insufficiency (VBI) were divided into an acupuncture group and a routine treatment group, 20 cases in each group. The acupuncture group were treated by routine treatment plus acupuncture. Transcranial Doppler ultrasonography and brain stem auditory evoked potentials (BAEP) before treatment and 2 weeks after treatment were determined to investigate the effects of acupuncture on blood flow velocity and brain electrophysiology in the patient of VBI. RESULTS: Before treatment, the blood velocity of vertebral artery and vertebrobasilar artery at bilateral sides in the patient of VBI decreased as compared with the control group, and the abnormal rate of TCD was 75.0% (30/40) and the abnormal rate of BAEP was 70.0% (28/40), characterized with brainstem abnormality type; after treatment, the blood velocity in the two groups was improved and the abnormal rate of TCD was 47.5% (19/40), and the abnormal rate of BEAP was 45.0% (18/40). The nerve conduction of the two groups was improved, the peak latency of V wave and interpeak latency of III-V and I -V in the acupuncture group were improved significantly as compared with the routine treatment group (P < 0.05). CONCLUSION: Acupuncture can improve the blood velocity of vertebrobasilar artery and the nerve conduction function of brainstem in the patient of vertebrobasilar insufficiency.

Acupuncture Therapy↗
PubMed1988

Calcium antagonists in an animal model of vertebrobasilar insufficiency.

Vertigo as a symptom of vertebrobasilar insufficiency (VBI) is a serious clinical problem in elderly patients. Recent epidemiologic studies have shown that patients with VBI run the same risk of developing complete cerebral infarction as do patients with TIAs. In order to study the efficacy of calcium antagonists in vertebrobasilar insufficiency, an animal model of VBI was developed by occluding one vertebral artery with a balloon catheter. Judging by the reversal of the nystagmic pattern of petite ecriture, the calcium antagonists flunarizine and nimodipine are effective drugs in this animal model of VBI.

Animals↗
PubMed1991

Nuclear hemodynamic vertebrobasilar insufficiency. A new approach with the xenon Xe 133 method.

Vertebrobasilar insufficiency is a well-known syndrome, but no corresponding hemodynamic deficit has yet been established. We propose to define nuclear hemodynamic vertebrobasilar insufficiency on the basis of an oligemia lower than 35 mL/100 g per minute in the brain stem-cerebellar region with use of the xenon Xe 133 inhalation method. Fifteen patients fulfilling this criterion underwent four-vessel angiography, computed tomography, and a standardized neurologic examination. An acetazolamide test showed poor reactivity in more than half of the patients, sometimes specifically in the vertebrobasilar area. With use of single-photon emission computed tomography and intravenous technetium Tc 99m-labeled hexamethylpropyleneamineoxime in two cases, the considerable decrease of regional cerebral blood flow in the brain stem-cerebellar region was confirmed. An excellent correlation was observed between the existence of nuclear hemodynamic vertebrobasilar insufficiency and angiographically proved arterial occlusions. The dominant nuclear oligemic zone was regularly on the side of the anatomic arterial chief lesion. Clinical manifestations included rare transient ischemic attacks (in one of 15 patients), intermittent basilar symptoms (in 15 of 15 patients), and a subacute vertebrobasilar "threatening" syndrome. Thus, imaging of a nuclear hemodynamic vertebrobasilar deficit provides an objective basis to the diagnosis of vertebrobasilar insufficiency and useful objective data for revascularization surgery.

Acetazolamide↗
PubMed1986

Embolic lesions from the subclavian artery causing transient vertebrobasilar insufficiency.

Thirteen patients with transient vertebrobasilar insufficiency caused by emboli from a proximal subclavian artery lesion were treated over a 5-year period. This group was characterized by the absence of significant carotid disease (12 of 13 patients) and equal arm pressures bilaterally in most patients (8 of 13 patients). An isolated supraclavicular bruit (12 of 13 patients) and a history of ipsilateral digital ischemia (5 of 13 patients) were common. Arch angiography demonstrated proximal subclavian lesions in 12 patients, with obvious ulcerations in 10 cases and thrombus in an old carotid-subclavian bypass graft in one case. Surgery directed at removal or exclusion of the lesion was successful in all cases. Isolated lesions in the subclavian artery can be a source of emboli into the vertebrobasilar circulation. These lesions are effectively treated by exclusion and vascular reconstruction.

Humans↗
PubMedDate not supplied

Cerebral evoked potentials in the chronic vertebrobasilar insufficiency.

The syndrome of chronic vertebrobasilar insufficiency (VBI) consists in a complex of symptoms, often mild and transient, and lacks a complementary system of objective paraclinical investigations able to certify its existence. The study of somato-sensory, auditory and visual evoked potentials in VBI showed the occurrence of changes regardless of the symptom importance both in disorders due to extrinsic causes: a) compression by a damage of the cervical column (92.9%, 50% and 63.9%, respectively; b) diseases of the cervical spinal cord (92.9% and 46.6%, respectively) and in disorders due to some intrinsic vascular causes such as atherosclerosis (62.5%, 88.8% and 87.5%, respectively). We described: a) local and far field modifications for the somesthetic evoked potentials (SEPs); b) modifications due to brain stem hypoxia (vestibular and auditory centres) or of the internal ear for the early and middle auditory potentials (AEPs); c) modifications due to lower perfusion of the occipital lobes and of the nonspecific centres in the brain stem for the visual evoked potentials (VEPs). The N0-P0-Na component of the middle auditory response was considered to represent a vestibular response and it was significantly affected in cases with VBI and clinical manifestations like: equilibrium disorders, nystagmus and vertigo. Typical images of the sensory evoked responses affected by VBI are reproduced considering their evidence as an elective method in the paraclinical examination of this syndrome.

Adult↗
PubMed2003

Electronystagmographic and caloric investigation data about vascular-vestibular dysfunction among patients with vertebrobasilar insufficiency.

Audiovestibular symptoms are the first and often the only clinical signs of vertebrobasilar insufficiency. The aim of our investigation was to analyze the results of caloric and electronystagmographic investigation of vascular-vestibular disorders among patients with vertebrobasilar insufficiency. We examined a total of 55 men (mean age, 51.8 +/- 8.2 years)--a primary group of 35 men with proven vascular-vestibular dysfunction and vertebrobasilar insufficiency and a control group of 20 clinically healthy men. Standard and electronystagmographic ("Tönnies" type) caloric tests were used to evaluate the human vestibular analyzer. Our data from this investigation show that in both rotatory and caloric tests, the slow-phase speed is the most important index about function of the vestibular analyzer.

Caloric Tests↗